As a health communication, multimedia and graphic design firm, we, like many others, are consumers of high quality royalty-free stock photography for the creation of health education materials for delivery in print or over the Web to various populations. Unfortunately, there is a dearth of readily available photographs that depict specific health conditions and behaviors. It also is difficult to locate images that match other visual characteristics of recipients such as race or socio-economic status. We performed two studies on the diversity in commercially-available stock art photographs that empirically confirmed that available images are, indeed, limited. We content analyzed 1,100 randomly-selected photographs from seven of the largest commercial stock art companies that are searchable online and found little diversity in terms of characteristics, settings, activities and health conditions. We then conducted an extended, targeted search of all online stock art services for six specific characteristic/health condition combinations and located only 89 photographs (only one combination had more than 10 photographs). The lack of diverse images for health education media and materials is a theoretic as well as practical problem. Several common theoretical approaches guiding successful health programs predict that health communication is more effective at changing behavior when sources and models are physically attractive and similar to the target audiences. The superiority of images depicting attractive and similar models/referents has been confirmed in research on persuasion and health communication. The purpose of this revised Phase I SBIR project is to demonstrate the feasibility of developing a collection of photographs depicting diverse settings, health behaviors, health conditions and demographics, called Real Health, that can be used by health and media professionals to increase the effectiveness of health communication by selecting images that are attractive yet similar to the recipients. The revised Phase I project will confirm the feasibility of Real Health by achieving the following: 1) recruiting and hiring "real" diverse people for the Real Health photographs;2) taking photographs of the models that meet professional quality standards;3) confirming that the photographs taken fill gaps identified in the initial exploratory content analysis in terms of demographic characteristics, health conditions and health behaviors, 4) ascertaining the digital image needs of public health practitioners in order to identify photographs to be included in a Phase II effectiveness trial, and 5) demonstrating the potential effectiveness of Real Health photographs at improving health communication for changing consumers'health behavior. The project will be conducted by Klein Buendel, Inc., along with several expert consultants and two major stock art companies. Revisions to the Phase I plan include fortifying the link between visual images and health improvement, clarifying feasibility test procedures, adding procedures for consenting vulnerable groups, and proposing a fifth feasibility test on consumers'preferences for Real Health photographs in health communication. PUBLIC HEALTH RELEVANCE: Sources and models depicted as attractive and similar to recipients can increase the impact of health messages by capturing attention, improving comprehension, engendering feelings of personalism and cultural appropriateness, and causing recipients to identify with them. Producing health communication that changes health behavior requires access to a much wider variety of photographs than currently available from commercial stock art companies in order to capitalize on the power of physically active and similar sources/models. The purpose of this Phase I SBIR project is to demonstrate the feasibility of developing a collection of photographs depicting diverse settings, activities, health conditions, and demographics called "Real Health" that can be used to increase the effectiveness of health communication.